Individual
MEGAN CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
120 VIRGINIA ST, BRIGHTON, IL 62012-1018
(618) 918-1036
Mailing address
120 VIRGINIA, BRIGHTON, IL 62012
(618) 918-1036
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004007
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165285321
—
IL
Enumeration date
04/08/2014
Last updated
04/08/2014
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